The effect of intraoperative 6% balanced hydroxyethyl starch (130/0.4) during cardiac surgery on transfusion requirements.
HANS, Grégory ; ; et al
in Journal of cardiothoracic and vascular anesthesia (2015), 29(2), 328-32
OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative ... [more ▼]
OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative fluid therapy. DESIGN: Data were obtained retrospectively from medical records and perfusion charts. Matching based on propensity scores was used to adjust for potential confounders. SETTING: A university hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass. INTERVENTIONS: Allocation to one of the study groups according to whether balanced HES or balanced crystalloids was used for pump prime and intraoperative fluid therapy. MEASUREMENTS AND MAIN RESULTS: 240 propensity-matched patients were retained for final analyses. Forty-eight patients (40%) of the colloid group and 28 patients (23.3%) of the crystalloid group received blood products, with an odd ratio (95% CI) of 2.1(1.2-3.8 (P=0.009). After bypass HES patients had lower hemoglobin levels (8.4 [1.3] gr/dL vs 9.6  gr/dL; P<0.001) and a higher cumulative chest drain output after 3 hours (180  mL vs 140  mL, P<0.001]. Heparinase thromboelastogram (TEG(R)) showed longer K times (2.5[1.1] vs 1.6[0.8], P<0.001) and lower maximal amplitudes (55.1[12.5] vs 63.4[9.8], P=0.008). CONCLUSIONS: HES patients required more transfusions, owing to greater hemodilution, HES-induced clotting disturbances, and bleeding. [less ▲]Detailed reference viewed: 8 (0 ULg)
Extravasation of albumin after cardiopulmonary bypass in newborns.
; ; et al
in Journal of Cardiothoracic and Vascular Anesthesia (2007), 21(2), 174-178
OBJECTIVE: The systemic inflammatory response to cardiopulmonary bypass (CPB) possibly increases microvascular permeability to plasma proteins, leading to capillary leak syndrome. The study was conducted ... [more ▼]
OBJECTIVE: The systemic inflammatory response to cardiopulmonary bypass (CPB) possibly increases microvascular permeability to plasma proteins, leading to capillary leak syndrome. The study was conducted to elucidate any protein leakage in newborns using Evans blue dye as tracer. DESIGN: Prospective controlled study. SETTING: University-affiliated heart center. PARTICIPANTS: Eleven neonates with transposition of the great arteries. INTERVENTIONS: Plasma interleukin-6 (IL-6), IL-10, fractional escape rate (FER) of an intravenous bolus of Evans blue, and colloid osmotic pressure (COP) were assessed before and after surgery (statistics: median and 25th-75th percentile, Friedman's 2-way analysis of variance, and Wilcoxon matched-pairs signed-rank test [before and after surgery]). MEASUREMENTS AND MAIN RESULTS: All patients had an uneventful intraoperative course. The demographic and operative data were age 11 (10-13) days, body weight 3.2 (3.0-3.3) kg, CPB time 132 (123-144) minutes, and aortic cross-clamp time 66 (64-78) minutes. The proinflammatory IL-6 increased 60-fold and the anti-inflammatory IL-10 only 3-fold after CPB. FER, however, was not changed, whereas COP was significantly reduced after CPB. CONCLUSIONS: In contrast to the expectation, the escape rate of Evans blue, reflecting the extravasation of albumin, was not increased after CPB. However, reduced COP, hypothermia, and also a reduced lymphatic drainage may contribute to edema formation. The present data do not support the hypothesis of a capillary leak after CPB in newborns. [less ▲]Detailed reference viewed: 26 (0 ULg)
Preoperative cardiogenic shock related to dynamic obstruction of left ventricular outflow in a patient with acute aortic dissection: diagnosis by transesophageal echocardiography
Canivet, Jean-Luc ; Sakalihasan, Natzi ; Creemers, Etienne et al
in Journal of Cardiothoracic and Vascular Anesthesia (1996), 10(6), 781-784Detailed reference viewed: 6 (1 ULg)